Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine
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摘要
BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.AIM To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.METHODS Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively. Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation, quantitative analysis was performed later on. Samples from fine needle aspiration(EUS-FNA) or surgical specimen served as gold standard.RESULTS CEH-EUS showed 39 hypoenhanced lesions, 3 non-enhanced and 13 hyperenhanced lesions. Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%, while other parameters such as arrival time, time to peak or area under the curve did not show additional value. 34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma; of the hyperenhanced lesions 4 were inflammatory, 3 neuroendocrine carcinomas, 1 lymphoma, 1 insulinoma and 4 metastases(2 of renal cell carcinoma, 2 of lung cancer). Non-enhanced lesions showed up as necroses. Sensitivity for the detection of pancreatic adenocarcinoma was 100%,specificity 87.2% for hypoenhancement alone; in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma(sensitivity and specificity 100%, PPV and NPV for adenocarcinoma 100%).CONCLUSION This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma. Additional quantitative analysis of perfusion parameters does not add diagnostic yield. In case of the various hyperenhanced pancreatic lesions in our data set, histologic sampling is essential for further treatment.
BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.AIM To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.METHODS Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively. Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation, quantitative analysis was performed later on. Samples from fine needle aspiration(EUS-FNA) or surgical specimen served as gold standard.RESULTS CEH-EUS showed 39 hypoenhanced lesions, 3 non-enhanced and 13 hyperenhanced lesions. Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%, while other parameters such as arrival time, time to peak or area under the curve did not show additional value. 34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma; of the hyperenhanced lesions 4 were inflammatory, 3 neuroendocrine carcinomas, 1 lymphoma, 1 insulinoma and 4 metastases(2 of renal cell carcinoma, 2 of lung cancer). Non-enhanced lesions showed up as necroses. Sensitivity for the detection of pancreatic adenocarcinoma was 100%,specificity 87.2% for hypoenhancement alone; in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma(sensitivity and specificity 100%, PPV and NPV for adenocarcinoma 100%).CONCLUSION This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma. Additional quantitative analysis of perfusion parameters does not add diagnostic yield. In case of the various hyperenhanced pancreatic lesions in our data set, histologic sampling is essential for further treatment.
BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.AIM To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.METHODS Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively. Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation, quantitative analysis was performed later on. Samples from fine needle aspiration(EUS-FNA) or surgical specimen served as gold standard.RESULTS CEH-EUS showed 39 hypoenhanced lesions, 3 non-enhanced and 13 hyperenhanced lesions. Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%, while other parameters such as arrival time, time to peak or area under the curve did not show additional value. 34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma; of the hyperenhanced lesions 4 were inflammatory, 3 neuroendocrine carcinomas, 1 lymphoma, 1 insulinoma and 4 metastases(2 of renal cell carcinoma, 2 of lung cancer). Non-enhanced lesions showed up as necroses. Sensitivity for the detection of pancreatic adenocarcinoma was 100%,specificity 87.2% for hypoenhancement alone; in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma(sensitivity and specificity 100%, PPV and NPV for adenocarcinoma 100%).CONCLUSION This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma. Additional quantitative analysis of perfusion parameters does not add diagnostic yield. In case of the various hyperenhanced pancreatic lesions in our data set, histologic sampling is essential for further treatment.
引文
1 Sedlack R,Affi A,Vazquez-Sequeiros E,Norton ID,Clain JE,Wiersema MJ.Utility of EUS in the evaluation of cystic pancreatic lesions.Gastrointest Endosc 2002;56:543-547[PMID:12297771DOI:10.1067/mge.2002.128106]
2 Kliment M,Urban O,Cegan M,Fojtik P,Falt P,Dvorackova J,Lovecek M,Straka M,Jaluvka F.Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses:the utility and impact on management of patients.Scand J Gastroenterol 2010;45:1372-1379[PMID:20626304 DOI:10.3109/00365521.2010.503966]
3 Gleeson FC,Kipp BR,Caudill JL,Clain JE,Clayton AC,Halling KC,Henry MR,Rajan E,Topazian MD,Wang KK,Wiersema MJ,Zhang J,Levy MJ.False positive endoscopic ultrasound fine needle aspiration cytology:incidence and risk factors.Gut 2010;59:586-593[PMID:20427392DOI:10.1136/gut.2009.187765]
4 Turner BG,Cizginer S,Agarwal D,Yang J,Pitman MB,Brugge WR.Diagnosis of pancreatic neoplasia with EUS and FNA:a report of accuracy.Gastrointest Endosc 2010;71:91-98[PMID:19846087 DOI:10.1016/j.gie.2009.06.017]
5 Laquière A,Lefort C,Maire F,Aubert A,Gincul R,Prat F,Grandval P,Croizet O,Boulant J,Vanbiervliet G,Pénaranda G,Lecomte L,Napoléon B,Boustière C.19 G nitinol needle versus 22G needle for transduodenal endoscopic ultrasound-guided sampling of pancreatic solid masses:a randomized study.Endoscopy 2018[PMID:30453379 DOI:10.1055/a-0757-7714]
6 Taylor B.Carcinoma of the head of the pancreas versus chronic pancreatitis:diagnostic dilemma with significant consequences.World J Surg 2003;27:1249-1257[PMID:14502404 DOI:10.1007/s00268-003-7245-8]
7 Fathy O,Wahab MA,Elghwalby N,Sultan A,EL-Ebidy G,Hak NG,Abu Zeid M,Abd-Allah T,El-Shobary M,Fouad A,Kandeel T,Abo Elenien A,Abd El-Raouf A,Hamdy E,Sultan AM,Hamdy E,Ezzat F.216 cases of pancreaticoduodenectomy:risk factors for postoperative complications.Hepatogastroenterology 2008;55:1093-1098[PMID:18705336]
8 Rettenbacher T.Focal liver lesions:role of contrast-enhanced ultrasound.Eur J Radiol 2007;64:173-182[PMID:17900841 DOI:10.1016/j.ejrad.2007.07.026]
9 Xu ZF,Xu HX,Xie XY,Liu GJ,Zheng YL,Liang JY,Lu MD.Renal cell carcinoma:real-time contrast-enhanced ultrasound findings.Abdom Imaging 2010;35:750-756[PMID:19844755 DOI:10.1007/s00261-009-9583-y]
10 Bertolotto M,Martegani A,Aiani L,Zappetti R,Cernic S,Cova MA.Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT.A feasibility study.Eur Radiol 2008;18:376-383[PMID:17851664 DOI:10.1007/s00330-007-0747-2]
11 Girlich C,Schacherer D,Lamby P,Scherer MN,Schreyer AG,Jung EM.Innovations in contrast enhanced high resolution ultrasound improve sonographic imaging of the intestine.Clin Hemorheol Microcirc 2010;45:207-215[PMID:20675901]
12 Kannengiesser K,Mahlke R,Petersen F,Peters A,Ross M,Kucharzik T,Maaser C.Contrastenhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors.Scand J Gastroenterol 2012;47:1515-1520[PMID:23148660DOI:10.3109/00365521.2012.729082]
13 Sanchez MV,Varadarajulu S,Napoleon B.EUS contrast agents:what is available,how do they work,and are they effective?Gastrointest Endosc 2009;69:S71-S77[PMID:19179175 DOI:10.1016/j.gie.2008.12.004]
14 Nakaizumi A,Uehara H,Iishi H,Tatsuta M,Kitamura T,Kuroda C,Ohigashi H,Ishikawa O,Okuda S.Endoscopic ultrasonography in diagnosis and staging of pancreatic cancer.Dig Dis Sci1995;40:696-700[PMID:7895567]
15 Reddymasu SC,Gupta N,Singh S,Oropeza-Vail M,Jafri SF,Olyaee M.Pancreato-biliary malignancy diagnosed by endoscopic ultrasonography in absence of a mass lesion on transabdominal imaging:prevalence and predictors.Dig Dis Sci 2011;56:1912-1916[PMID:21188524 DOI:10.1007/s10620-010-1511-z]
16 Kitano M,Sakamoto H,Matsui U,Ito Y,Maekawa K,von Schrenck T,Kudo M.A novel perfusion imaging technique of the pancreas:contrast-enhanced harmonic EUS(with video).Gastrointest Endosc 2008;67:141-150[PMID:18155437 DOI:10.1016/j.gie.2007.07.045]
17 Imazu H,Uchiyama Y,Matsunaga K,Ikeda K,Kakutani H,Sasaki Y,Sumiyama K,Ang TL,Omar S,Tajiri H.Contrast-enhanced harmonic EUS with novel ultrasonographic contrast(Sonazoid)in the preoperative T-staging for pancreaticobiliary malignancies.Scand JGastroenterol 2010;45:732-738[PMID:20205504 DOI:10.3109/00365521003690269]
18 Hocke M,Ignee A,Dietrich CF.Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis.Endoscopy 2011;43:163-165[PMID:21165827 DOI:10.1055/s-0030-1256022]
19 Napoleon B,Alvarez-Sanchez MV,Gincoul R,Pujol B,Lefort C,Lepilliez V,Labadie M,Souquet JC,Queneau PE,Scoazec JY,Chayvialle JA,Ponchon T.Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas:results of a pilot study.Endoscopy 2010;42:564-570[PMID:20593334 DOI:10.1055/s-0030-1255537]
20 Kitano M,Kudo M,Yamao K,Takagi T,Sakamoto H,Komaki T,Kamata K,Imai H,Chiba Y,Okada M,Murakami T,Takeyama Y.Characterization of small solid tumors in the pancreas:the value of contrast-enhanced harmonic endoscopic ultrasonography.Am J Gastroenterol 2012;107:303-310[PMID:22008892 DOI:10.1038/ajg.2011.354]
21 Matsubara H,Itoh A,Kawashima H,Kasugai T,Ohno E,Ishikawa T,Itoh Y,Nakamura Y,Hiramatsu T,Nakamura M,Miyahara R,Ohmiya N,Ishigami M,Katano Y,Goto H,Hirooka Y.Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases.Pancreas 2011;40:1073-1079[PMID:21633317 DOI:10.1097/MPA.0b013e31821f57b7]
22 S?ftoiu A,Vilmann P,Dietrich CF,Iglesias-Garcia J,Hocke M,Seicean A,Ignee A,Hassan H,Streba CT,Ioncic?AM,Gheonea DI,Ciurea T.Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses(with videos).Gastrointest Endosc 2015;82:59-69[PMID:25792386 DOI:10.1016/j.gie.2014.11.040]
23 Yamashita Y,Kato J,Ueda K,Nakamura Y,Kawaji Y,Abe H,Nuta J,Tamura T,Itonaga M,Yoshida T,Maeda H,Maekita T,Iguchi M,Tamai H,Ichinose M.Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors.Biomed Res Int 2015;2015:491782[PMID:26090411 DOI:10.1155/2015/491782]
24 Gheonea DI,Streba CT,Ciurea T,S?ftoiu A.Quantitative low mechanical index contrastenhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer.BMC Gastroenterol 2013;13:2[PMID:23286918 DOI:10.1186/1471-230X-13-2]
25 Gong TT,Hu DM,Zhu Q.Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions:a meta-analysis.Gastrointest Endosc 2012;76:301-309[PMID:22703697 DOI:10.1016/j.gie.2012.02.051]
26 Park JS,Kim HK,Bang BW,Kim SG,Jeong S,Lee DH.Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses.World JGastroenterol 2014;20:518-524[PMID:24574720 DOI:10.3748/wjg.v20.i2.518]
27 Iglesias-Garcia J,Domínguez-Mu?oz JE,Casti?eira-Alvari?o M,Luaces-Regueira M,Lari?oNoia J.Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis.Endoscopy 2013;45:781-788[PMID:24019131 DOI:10.1055/s-0033-1344614]
28 S?ftoiu A,Vilmann P.Differential diagnosis of focal pancreatic masses by semiquantitative EUSelastography:between strain ratios and strain histograms.Gastrointest Endosc 2013;78:188-189[PMID:23820413 DOI:10.1016/j.gie.2013.01.024]
29 Gincul R,Palazzo M,Pujol B,Tubach F,Palazzo L,Lefort C,Fumex F,Lombard A,Ribeiro D,Fabre M,Hervieu V,Labadie M,Ponchon T,Napoléon B.Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma:a prospective multicenter trial.Endoscopy 2014;46:373-379[PMID:24532350 DOI:10.1055/s-0034-1364969]
30 Kurt M,Oguz D,Oztas E,Kalkan IH,Sayilir A,Beyazit Y,Sasmaz N.Safety of endoscopic ultrasonography in elderly patients:a single center prospective trial.Aging Clin Exp Res 2013;25:571-574[PMID:24026626 DOI:10.1007/s40520-013-0138-2]
31 Madhoun MF,Wani SB,Rastogi A,Early D,Gaddam S,Tierney WM,Maple JT.The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions:a meta-analysis.Endoscopy 2013;45:86-92[PMID:23307148DOI:10.1055/s-0032-1325992]
32 Kien-Fong Vu C,Chang F,Doig L,Meenan J.A prospective control study of the safety and cellular yield of EUS-guided FNA or Trucut biopsy in patients taking aspirin,nonsteroidal antiinflammatory drugs,or prophylactic low molecular weight heparin.Gastrointest Endosc 2006;63:808-813[PMID:16650543 DOI:10.1016/j.gie.2005.09.033]
33 Levy MJ,Gleeson FC,Campion MB,Caudill JL,Clain JE,Halling K,Rajan E,Topazian MD,Wang KK,Wiersema MJ,Clayton A.Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS:a potential source of false-positive FNA and needle tract seeding.Am J Gastroenterol 2010;105:1311-1318[PMID:20197762 DOI:10.1038/ajg.2010.80]
34 Levy MJ,Norton ID,Wiersema MJ,Schwartz DA,Clain JE,Vazquez-Sequeiros E,Wilson WR,Zinsmeister AR,Jondal ML.Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA.Gastrointest Endosc 2003;57:672-678[PMID:12709695 DOI:10.1067/mge.2003.204]
35 Tomonari A,Katanuma A,Matsumori T,Yamazaki H,Sano I,Minami R,Sen-yo M,Ikarashi S,Kin T,Yane K,Takahashi K,Shinohara T,Maguchi H.Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma.World J Gastroenterol 2015;21:8458-8461[PMID:26217099 DOI:10.3748/wjg.v21.i27.8458]
2 Kliment M,Urban O,Cegan M,Fojtik P,Falt P,Dvorackova J,Lovecek M,Straka M,Jaluvka F.Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses:the utility and impact on management of patients.Scand J Gastroenterol 2010;45:1372-1379[PMID:20626304 DOI:10.3109/00365521.2010.503966]
3 Gleeson FC,Kipp BR,Caudill JL,Clain JE,Clayton AC,Halling KC,Henry MR,Rajan E,Topazian MD,Wang KK,Wiersema MJ,Zhang J,Levy MJ.False positive endoscopic ultrasound fine needle aspiration cytology:incidence and risk factors.Gut 2010;59:586-593[PMID:20427392DOI:10.1136/gut.2009.187765]
4 Turner BG,Cizginer S,Agarwal D,Yang J,Pitman MB,Brugge WR.Diagnosis of pancreatic neoplasia with EUS and FNA:a report of accuracy.Gastrointest Endosc 2010;71:91-98[PMID:19846087 DOI:10.1016/j.gie.2009.06.017]
5 Laquière A,Lefort C,Maire F,Aubert A,Gincul R,Prat F,Grandval P,Croizet O,Boulant J,Vanbiervliet G,Pénaranda G,Lecomte L,Napoléon B,Boustière C.19 G nitinol needle versus 22G needle for transduodenal endoscopic ultrasound-guided sampling of pancreatic solid masses:a randomized study.Endoscopy 2018[PMID:30453379 DOI:10.1055/a-0757-7714]
6 Taylor B.Carcinoma of the head of the pancreas versus chronic pancreatitis:diagnostic dilemma with significant consequences.World J Surg 2003;27:1249-1257[PMID:14502404 DOI:10.1007/s00268-003-7245-8]
7 Fathy O,Wahab MA,Elghwalby N,Sultan A,EL-Ebidy G,Hak NG,Abu Zeid M,Abd-Allah T,El-Shobary M,Fouad A,Kandeel T,Abo Elenien A,Abd El-Raouf A,Hamdy E,Sultan AM,Hamdy E,Ezzat F.216 cases of pancreaticoduodenectomy:risk factors for postoperative complications.Hepatogastroenterology 2008;55:1093-1098[PMID:18705336]
8 Rettenbacher T.Focal liver lesions:role of contrast-enhanced ultrasound.Eur J Radiol 2007;64:173-182[PMID:17900841 DOI:10.1016/j.ejrad.2007.07.026]
9 Xu ZF,Xu HX,Xie XY,Liu GJ,Zheng YL,Liang JY,Lu MD.Renal cell carcinoma:real-time contrast-enhanced ultrasound findings.Abdom Imaging 2010;35:750-756[PMID:19844755 DOI:10.1007/s00261-009-9583-y]
10 Bertolotto M,Martegani A,Aiani L,Zappetti R,Cernic S,Cova MA.Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT.A feasibility study.Eur Radiol 2008;18:376-383[PMID:17851664 DOI:10.1007/s00330-007-0747-2]
11 Girlich C,Schacherer D,Lamby P,Scherer MN,Schreyer AG,Jung EM.Innovations in contrast enhanced high resolution ultrasound improve sonographic imaging of the intestine.Clin Hemorheol Microcirc 2010;45:207-215[PMID:20675901]
12 Kannengiesser K,Mahlke R,Petersen F,Peters A,Ross M,Kucharzik T,Maaser C.Contrastenhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors.Scand J Gastroenterol 2012;47:1515-1520[PMID:23148660DOI:10.3109/00365521.2012.729082]
13 Sanchez MV,Varadarajulu S,Napoleon B.EUS contrast agents:what is available,how do they work,and are they effective?Gastrointest Endosc 2009;69:S71-S77[PMID:19179175 DOI:10.1016/j.gie.2008.12.004]
14 Nakaizumi A,Uehara H,Iishi H,Tatsuta M,Kitamura T,Kuroda C,Ohigashi H,Ishikawa O,Okuda S.Endoscopic ultrasonography in diagnosis and staging of pancreatic cancer.Dig Dis Sci1995;40:696-700[PMID:7895567]
15 Reddymasu SC,Gupta N,Singh S,Oropeza-Vail M,Jafri SF,Olyaee M.Pancreato-biliary malignancy diagnosed by endoscopic ultrasonography in absence of a mass lesion on transabdominal imaging:prevalence and predictors.Dig Dis Sci 2011;56:1912-1916[PMID:21188524 DOI:10.1007/s10620-010-1511-z]
16 Kitano M,Sakamoto H,Matsui U,Ito Y,Maekawa K,von Schrenck T,Kudo M.A novel perfusion imaging technique of the pancreas:contrast-enhanced harmonic EUS(with video).Gastrointest Endosc 2008;67:141-150[PMID:18155437 DOI:10.1016/j.gie.2007.07.045]
17 Imazu H,Uchiyama Y,Matsunaga K,Ikeda K,Kakutani H,Sasaki Y,Sumiyama K,Ang TL,Omar S,Tajiri H.Contrast-enhanced harmonic EUS with novel ultrasonographic contrast(Sonazoid)in the preoperative T-staging for pancreaticobiliary malignancies.Scand JGastroenterol 2010;45:732-738[PMID:20205504 DOI:10.3109/00365521003690269]
18 Hocke M,Ignee A,Dietrich CF.Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis.Endoscopy 2011;43:163-165[PMID:21165827 DOI:10.1055/s-0030-1256022]
19 Napoleon B,Alvarez-Sanchez MV,Gincoul R,Pujol B,Lefort C,Lepilliez V,Labadie M,Souquet JC,Queneau PE,Scoazec JY,Chayvialle JA,Ponchon T.Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas:results of a pilot study.Endoscopy 2010;42:564-570[PMID:20593334 DOI:10.1055/s-0030-1255537]
20 Kitano M,Kudo M,Yamao K,Takagi T,Sakamoto H,Komaki T,Kamata K,Imai H,Chiba Y,Okada M,Murakami T,Takeyama Y.Characterization of small solid tumors in the pancreas:the value of contrast-enhanced harmonic endoscopic ultrasonography.Am J Gastroenterol 2012;107:303-310[PMID:22008892 DOI:10.1038/ajg.2011.354]
21 Matsubara H,Itoh A,Kawashima H,Kasugai T,Ohno E,Ishikawa T,Itoh Y,Nakamura Y,Hiramatsu T,Nakamura M,Miyahara R,Ohmiya N,Ishigami M,Katano Y,Goto H,Hirooka Y.Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases.Pancreas 2011;40:1073-1079[PMID:21633317 DOI:10.1097/MPA.0b013e31821f57b7]
22 S?ftoiu A,Vilmann P,Dietrich CF,Iglesias-Garcia J,Hocke M,Seicean A,Ignee A,Hassan H,Streba CT,Ioncic?AM,Gheonea DI,Ciurea T.Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses(with videos).Gastrointest Endosc 2015;82:59-69[PMID:25792386 DOI:10.1016/j.gie.2014.11.040]
23 Yamashita Y,Kato J,Ueda K,Nakamura Y,Kawaji Y,Abe H,Nuta J,Tamura T,Itonaga M,Yoshida T,Maeda H,Maekita T,Iguchi M,Tamai H,Ichinose M.Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors.Biomed Res Int 2015;2015:491782[PMID:26090411 DOI:10.1155/2015/491782]
24 Gheonea DI,Streba CT,Ciurea T,S?ftoiu A.Quantitative low mechanical index contrastenhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer.BMC Gastroenterol 2013;13:2[PMID:23286918 DOI:10.1186/1471-230X-13-2]
25 Gong TT,Hu DM,Zhu Q.Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions:a meta-analysis.Gastrointest Endosc 2012;76:301-309[PMID:22703697 DOI:10.1016/j.gie.2012.02.051]
26 Park JS,Kim HK,Bang BW,Kim SG,Jeong S,Lee DH.Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses.World JGastroenterol 2014;20:518-524[PMID:24574720 DOI:10.3748/wjg.v20.i2.518]
27 Iglesias-Garcia J,Domínguez-Mu?oz JE,Casti?eira-Alvari?o M,Luaces-Regueira M,Lari?oNoia J.Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis.Endoscopy 2013;45:781-788[PMID:24019131 DOI:10.1055/s-0033-1344614]
28 S?ftoiu A,Vilmann P.Differential diagnosis of focal pancreatic masses by semiquantitative EUSelastography:between strain ratios and strain histograms.Gastrointest Endosc 2013;78:188-189[PMID:23820413 DOI:10.1016/j.gie.2013.01.024]
29 Gincul R,Palazzo M,Pujol B,Tubach F,Palazzo L,Lefort C,Fumex F,Lombard A,Ribeiro D,Fabre M,Hervieu V,Labadie M,Ponchon T,Napoléon B.Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma:a prospective multicenter trial.Endoscopy 2014;46:373-379[PMID:24532350 DOI:10.1055/s-0034-1364969]
30 Kurt M,Oguz D,Oztas E,Kalkan IH,Sayilir A,Beyazit Y,Sasmaz N.Safety of endoscopic ultrasonography in elderly patients:a single center prospective trial.Aging Clin Exp Res 2013;25:571-574[PMID:24026626 DOI:10.1007/s40520-013-0138-2]
31 Madhoun MF,Wani SB,Rastogi A,Early D,Gaddam S,Tierney WM,Maple JT.The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions:a meta-analysis.Endoscopy 2013;45:86-92[PMID:23307148DOI:10.1055/s-0032-1325992]
32 Kien-Fong Vu C,Chang F,Doig L,Meenan J.A prospective control study of the safety and cellular yield of EUS-guided FNA or Trucut biopsy in patients taking aspirin,nonsteroidal antiinflammatory drugs,or prophylactic low molecular weight heparin.Gastrointest Endosc 2006;63:808-813[PMID:16650543 DOI:10.1016/j.gie.2005.09.033]
33 Levy MJ,Gleeson FC,Campion MB,Caudill JL,Clain JE,Halling K,Rajan E,Topazian MD,Wang KK,Wiersema MJ,Clayton A.Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS:a potential source of false-positive FNA and needle tract seeding.Am J Gastroenterol 2010;105:1311-1318[PMID:20197762 DOI:10.1038/ajg.2010.80]
34 Levy MJ,Norton ID,Wiersema MJ,Schwartz DA,Clain JE,Vazquez-Sequeiros E,Wilson WR,Zinsmeister AR,Jondal ML.Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA.Gastrointest Endosc 2003;57:672-678[PMID:12709695 DOI:10.1067/mge.2003.204]
35 Tomonari A,Katanuma A,Matsumori T,Yamazaki H,Sano I,Minami R,Sen-yo M,Ikarashi S,Kin T,Yane K,Takahashi K,Shinohara T,Maguchi H.Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma.World J Gastroenterol 2015;21:8458-8461[PMID:26217099 DOI:10.3748/wjg.v21.i27.8458]